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Project SITUP: An Interdisciplinary Quality Improvement Initiative to Reduce Aspiration Pneumonia


Published on: 08.27.2018
Associated with: April/June 2018, Volume 33, Issue 2; Journal of Nursing Care Quality. 33(2):116-122, April/June 2018

Learn about this QI initiative to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased. After watching this video, be sure to read the article.

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Creator: Soncrant, Christina MPH; Neily, Julia RN, MS, MPH; Bulat, Tatjana MD, CMD; Mills, Peter D. PhD, MS
Duration: 8:08
Injurious falls continue to challenge health care. Learn about this study that analyzed root cause analysis reports on falls and coded injury type, fall type, location, and root causes. There were 154 reported fall RCAs during the study period. Most (83%, n = 128) falls resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). Patients who fell were not wearing hip or head protection. These interventions may help prevent future injurious falls. After you watch this informative video, read the full article.
Creator: McClain, Jesse V. IV DNP, APRN, ACNS-BC, CCRN, MSCN, SCRN; Chance, Elisha A. BSAS, CCRC
Duration: 2:45
An advanced practice registered nurse (APRN) led a transitional care clinic for stroke survivors. The goal was to improve transitions from hospital to home. Patients seen in the clinic had a lower 30-day readmission rate (1.5%) compared to non clinic patients (13.4%), p = .003). The 90-day readmission proportion was also higher in nonclinic patients (12.8%) vs those seen in the clinic (4.4%), p = .058. The results suggest the APRN-led clinic may impact hospital readmissions in stroke/transient ischemic attack survivors.
Creator: Hagle, Mary PhD, RN-BC, FAAN; Dwyer, Darcy DNP, RN, ACNS-BC; Gettrust, Lynn DNP, RN, ACNS-BC; Lusk, Dana DNP, RN, CHPN, AHN-BC; Peterson, Kristen BSN, RN; Tennies, Sherry MSN-Ed, RN-BC, CWOCN
Duration: 2:57
The I3 (Inquiry, Improvement, and Innovation) Model was developed to guide EBP and QI projects, research studies, and innovation. The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model is used for guiding projects in the health care system.
Creator: Loftin, Edwin DNP, RN, NEA-BC, FACHE; Andrews, Diane PhD, RN; Mikitarian, George DHA, FACHE; LaManna, Jacqueline PhD, APRN, ANP-BC, BC-ADM, CDE
Duration: 2:14
The purpose of this QI project was to achieve zero preventable harm to patients during transitions in care from the emergency department to medical/surgical areas. Once the initial design was complete, small tests of change were deployed until zero harm was achieved. This is a replicable project so after watching the video be sure to read the article.
Creator: Oh, Jong Hee MS, RN, CNL, CRNI, VA-BC; Shelly, Mark MD; Nersinger, Sharon MS, RN, NEA-BC; Cai, Xueya PhD; Olsan, Tobie PhD, RN, NEA-BC, CNL, FNAP
Duration: 4:40
A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to clinically indicated replacement. Guided by Lean principles, a clinical nurse leader led a QI small test of change on a 38-bed medical unit. Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, and improved efficiency. Learn about this project in the video and article.
Creator: Mundle, William RN, MN, CMSN(C); Howell-Belle, Carnett RN, MN; Jeffs, Lianne PhD, RN, FAAN
Duration: 4:10
Catheter-associated urinary tract infections (CAUTIs) rates in our unit were higher when compared with the overall hospital rates. An interprofessional working group developed and implemented a QI bundled approach to reduce CAUTIs. There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates.
Creator: Hart, Danielle RN (EC); Hopman, Wilma M. MA; Hammond, Sharlene BN, RN; Redfearn, Damian P.
Duration: 3:12
Atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED). A nurse practitioner developed a new program to improve AF care after an ED visit, which included contacting patients by telephone. Telephone contact was highly effective: 37 of 90 patients with AF presented to the ED prior to telephone contact and 7 of 90 patients did so post–telephone contact (P < .001). Telephone practice led by an NP provides an opportunity to improve assessment and management of patient care. Learn more about this intervention in this video and read the full article.
Creator: McNeill, Margaret M. PhD, RN, APRN-CNS, CCRN-K, CCNS, TCRN, CPAN, NE-BC, NHDP-BC, FAAN; Archer, Susan DNP, RN, APRN-CNS, CCRN; Remsburg, Dana MSN, RN, CCRN; Storer, Jill BSN, RN; Rudman, Heather BSN, RN
Duration: 5:07
Using a rapid response team (RRT) and quality champion (QC) nurses at a community hospital provides benefits not entirely captured by analysis of mortality data. The purpose of this study was to determine the perceived benefits of the RRT at our facility and behaviors and activities observed during actual RRT responses. This was a mixed-method study including qualitative (interviews, focus groups, and surveys) and quantitative (retrospective chart reviews) data collection. Benefits of the RRT-QC registered nurse were extensive. Observations showed support, education, and teamwork in an effort to improve outcomes and support clinicians.
Creator: Smith, Catherine V. DNP, RN, CCNS, CCRN; Maduro, Ralitsa S. PhD; Morgan, Merri K. DNP, RN, CCRN; Ver Schneider, Patricia; Rutledge, Carolyn M. PhD, FNP-BC; Zimbro, Kathie S. PhD, RN
Duration: 5:53
Palliative care (PC) referrals are often underutilized or delayed. To improve referrals, interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting. Following implementation, median time to PC referral decreased by 2 days. Length of stay, direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility. Learn about the project in this video and then read the article: You can get CE credits for this article!
Creator: Hedges, Christine, PhD, RN, NE-BC; Hunt, Candice, MHA; Ball, Pamela, BSN, RN, NE-BC
Duration: 2:44
A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for Quiet Time (QT) and used HCAHPS “always quiet” scores as the primary outcome measure. The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. Quiet scores improved on both units after 11 months. You will appreciate the level of noise patients experience in hospitals (watch this video for a demonstration) and learn more about QT intervention – you can implement QT in your settings. Don’t miss this video and article (and get your Continuing Education).
Creator: Schwartz, Franklin, DNP, APRN, PMHNP-BC; Bjorklund, Pamela, PhD, APRN, PMHNP-BC, CNS-BC
Duration: 3:58
In this video, the author describes a violence management program that she and her coauthor piloted on a general medical unit following staff requests for measures to protect them from patient and visitor violence. An independent pre/posttest design measured changes in participant knowledge. The Staff Observation Assessment Scale Revised (SOAS-R) was used for data collection on aggression pre- and postimplementation. The violence management training program included in situ simulation training in de-escalation techniques. Knowledge of de-escalation techniques to reduce violence risk increased. In the article the authors share important lessons for ongoing program implementation.
Creator: Shoqirat, Noordeen, PhD; Mahasneh, Deema, PhD, MSc, RGN; Dardas, Latefa, PhD, PMHN; Singh, Charleen, PhD, MSc, RGN, Neuro-SN; Khresheh, Reham, PhD
Duration: 1:25
The purpose of this study was to qualitatively analyze nursing documentation of pain management among postoperative patients in Jordan. A documentary analysis method was used. A purposive sample of 80 medical records were reviewed, and a total of 720 nursing records were analyzed. The analysis revealed that nurses' documentation of pain management was limited, vague, incomplete, and largely dependent on their subjective evaluation. There also was little documented evidence of efforts to evaluate the effectiveness of pain management interventions. Dr Shoqirat explains the study in this video, and you can learn more about the study in his article.
Creator: Misto, Kara, PhD, RN; Padula, Cynthia, PhD, RN; Bryand, Elizabeth, BSN, RN-BC; Nadeau, Kate, MPH, RN
Duration: 5:16
While there are many benefits of EMR documentation, the presence of a computer may adversely affect provider-patient interaction. The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses. Nurses identified benefits and challenges to EMR documentation and strategies to maintain therapeutic relationships and communication. Dr Misto explains the study in this video and article.
Creator: Siegel, Sharon, RD, LD; Fan, Linlin, PhD; Goldman, Amanda, MS, RD, LD, FAND; Higgins, Joseph, MS, RD, LD; Goates, Scott, PhD, MBA; Partridge, Jamie, PhD, MBA
Duration: 6:07
Despite its high prevalence, malnutrition in hospitalized patients often goes unrecognized and undertreated. In this initiative nurses screened patients on admission using the Malnutrition Screening Tool and initiated oral nutrition supplements for patients at risk. A review of the medical records of 20 697 adult patients revealed that the average time from hospital admission to oral nutrition supplement initiation was reduced by 20 hours (20.8%), and length of stay also decreased for patients at nutritional risk. Watch this outstanding video to learn about this project and share the article with colleagues: it is open-access.
Creator: Spano-Szekely, Lauraine, DNP, RN; Winkler, Anne, MA, RN, CCRN; Waters, Cathy, MSN, RN, OCN, NEA-BC; Dealmeida, Susana, MHA, RN-C; Brandt, Kathy, RPh; Williamson, Marsha, MSN, RN-BC, ANP-BC, CCRN-K; Blum, Christina, BSN, RN; Gasper, Lori, BSN, RN; Wright,
Duration: 1:09
Learn how this team evaluated their hospital's fall prevention program and decreased their fall rate – watch the video and be sure to read their article. The team used a clinical practice guideline with 7 key practices to develop an individualized fall prevention program with multiple interventions (nurse-driven mobility assessment, purposeful hourly rounding, video monitoring for confused and impulsive fall-risk patients, and others). The fall rate decreased to 1.14, with a 72% expense reduction based on decreased sitter usage.
Creator: Reynolds, Staci Sue, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN
Duration: 3:56
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line–associated bloodstream infections (CLABSIs). Using the Grol and Wensing Model of Implementation as a guide, this study examined whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU. Following implementation, infection rates decreased, and improvements were seen across all process measures. After watching the video, read this article to learn more about strategies to implement evidence, which you can use in your own setting.
Creator:
Duration: 6:29
Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient/ family engagement to reduction of harm is not well understood. Dr Schenk, in her first study, identified an opportunity for reducing risk and harm by more actively engaging patients and families in the effort. In another study her team convened a Patient Safety Advisory Panel to explore potential interventions to increase patient/family engagement with safety. The preferred intervention was Speak Up-My Advocate for Patient Safety. Learn about these studies in the video and implications for engaging patients and families in your own settings of care. Be sure to read both articles.
Creator:
Duration: 3:34
Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing the patient's nutritional care plan. The combined interventions of staff engagement, redesigning the model of care to reprioritize activities at mealtimes, clarifying nutritional care roles and responsibilities, introducing a protected mealtime and a novel 2-tiered colored tray system, and implementing an awareness and education program have resulted in significant improvements in mealtime assistance. Learn more about this project from the authors in the video and their article.
Creator: Marilyn Oermann
Duration:
This is the first video in our writing for publication series. The purpose of the manuscript and intended readers guide your selection of a journal for submission. Learn about directories of nursing and other journals and sending a query email.
Creator: Marilyn Oermann
Duration:
This is the 2nd video in our writing for publication series. Learn about the journal’s Information for Authors and why important, formats for writing different types of manuscripts, and reporting guidelines. The video will prepare you for writing papers about quality improvement and using the SQUIRE guidelines. References and tables/figures also are discussed.



Creator: Soncrant, Christina MPH; Neily, Julia RN, MS, MPH; Bulat, Tatjana MD, CMD; Mills, Peter D. PhD, MS
Duration: 8:08
Injurious falls continue to challenge health care. Learn about this study that analyzed root cause analysis reports on falls and coded injury type, fall type, location, and root causes. There were 154 reported fall RCAs during the study period. Most (83%, n = 128) falls resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). Patients who fell were not wearing hip or head protection. These interventions may help prevent future injurious falls. After you watch this informative video, read the full article.
Creator: McClain, Jesse V. IV DNP, APRN, ACNS-BC, CCRN, MSCN, SCRN; Chance, Elisha A. BSAS, CCRC
Duration: 2:45
An advanced practice registered nurse (APRN) led a transitional care clinic for stroke survivors. The goal was to improve transitions from hospital to home. Patients seen in the clinic had a lower 30-day readmission rate (1.5%) compared to non clinic patients (13.4%), p = .003). The 90-day readmission proportion was also higher in nonclinic patients (12.8%) vs those seen in the clinic (4.4%), p = .058. The results suggest the APRN-led clinic may impact hospital readmissions in stroke/transient ischemic attack survivors.
Creator: Hagle, Mary PhD, RN-BC, FAAN; Dwyer, Darcy DNP, RN, ACNS-BC; Gettrust, Lynn DNP, RN, ACNS-BC; Lusk, Dana DNP, RN, CHPN, AHN-BC; Peterson, Kristen BSN, RN; Tennies, Sherry MSN-Ed, RN-BC, CWOCN
Duration: 2:57
The I3 (Inquiry, Improvement, and Innovation) Model was developed to guide EBP and QI projects, research studies, and innovation. The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model is used for guiding projects in the health care system.
Creator: Loftin, Edwin DNP, RN, NEA-BC, FACHE; Andrews, Diane PhD, RN; Mikitarian, George DHA, FACHE; LaManna, Jacqueline PhD, APRN, ANP-BC, BC-ADM, CDE
Duration: 2:14
The purpose of this QI project was to achieve zero preventable harm to patients during transitions in care from the emergency department to medical/surgical areas. Once the initial design was complete, small tests of change were deployed until zero harm was achieved. This is a replicable project so after watching the video be sure to read the article.
Creator: Oh, Jong Hee MS, RN, CNL, CRNI, VA-BC; Shelly, Mark MD; Nersinger, Sharon MS, RN, NEA-BC; Cai, Xueya PhD; Olsan, Tobie PhD, RN, NEA-BC, CNL, FNAP
Duration: 4:40
A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to clinically indicated replacement. Guided by Lean principles, a clinical nurse leader led a QI small test of change on a 38-bed medical unit. Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, and improved efficiency. Learn about this project in the video and article.
Creator: Mundle, William RN, MN, CMSN(C); Howell-Belle, Carnett RN, MN; Jeffs, Lianne PhD, RN, FAAN
Duration: 4:10
Catheter-associated urinary tract infections (CAUTIs) rates in our unit were higher when compared with the overall hospital rates. An interprofessional working group developed and implemented a QI bundled approach to reduce CAUTIs. There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates.
Creator: Misto, Kara, PhD, RN; Padula, Cynthia, PhD, RN; Bryand, Elizabeth, BSN, RN-BC; Nadeau, Kate, MPH, RN
Duration: 5:16
While there are many benefits of EMR documentation, the presence of a computer may adversely affect provider-patient interaction. The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses. Nurses identified benefits and challenges to EMR documentation and strategies to maintain therapeutic relationships and communication. Dr Misto explains the study in this video and article.
Creator: Spano-Szekely, Lauraine, DNP, RN; Winkler, Anne, MA, RN, CCRN; Waters, Cathy, MSN, RN, OCN, NEA-BC; Dealmeida, Susana, MHA, RN-C; Brandt, Kathy, RPh; Williamson, Marsha, MSN, RN-BC, ANP-BC, CCRN-K; Blum, Christina, BSN, RN; Gasper, Lori, BSN, RN; Wright,
Duration: 1:09
Learn how this team evaluated their hospital's fall prevention program and decreased their fall rate – watch the video and be sure to read their article. The team used a clinical practice guideline with 7 key practices to develop an individualized fall prevention program with multiple interventions (nurse-driven mobility assessment, purposeful hourly rounding, video monitoring for confused and impulsive fall-risk patients, and others). The fall rate decreased to 1.14, with a 72% expense reduction based on decreased sitter usage.
Creator: Reynolds, Staci Sue, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN
Duration: 3:56
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line–associated bloodstream infections (CLABSIs). Using the Grol and Wensing Model of Implementation as a guide, this study examined whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU. Following implementation, infection rates decreased, and improvements were seen across all process measures. After watching the video, read this article to learn more about strategies to implement evidence, which you can use in your own setting.
Creator: Marilyn Oermann
Duration:
This is the first video in our writing for publication series. The purpose of the manuscript and intended readers guide your selection of a journal for submission. Learn about directories of nursing and other journals and sending a query email.
Creator:
Duration: 2:55
The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
Creator:
Duration: 3:11
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. The author analyzed organizational data to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. You will enjoy watching this innovative video and will learn a lot from it (and be sure to also read the article).
Creator:
Duration: 4:08
Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
Creator:
Duration: 7:53
Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The author explains their study to validate use of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, with a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio. After you watch the video, take time to read the article.
Creator:
Duration: 4:04
Learn more about this study that examined the implementation of handoff as part of TeamSTEPPS initiatives for improving shift-change communication. The authors conducted on-site interviews and made observations in 8 critical access hospitals. Facilitators and barriers were different between high and low performing hospitals. Staff involvement and being part of the “big picture” were important facilitators to change management and buy-in. After viewing this video, read the article to learn more about this important study.
Creator:
Duration: 4:43
The authors developed an evidence-based alarm management strategy and describe their project in this video. The alarm management program reduced alarms up to 30%. Evaluation of patients on continuous cardiac monitoring showed a 3.5% decrease in census. This alarm management strategy has the potential to save $136 500 and 841 hours of registered nurses' time per year. Make sure you read their article too.
Creator:
Duration: 3:18
Dr. Rahn examined the relationships between nursing teamwork and NDNQI outcomes including pressure ulcers, falls, and catheter-associated urinary tract infections, and she found some significant relationships. Improving teamwork in medical-surgical acute care units can transform care and impact the occurrence of preventable adverse outcomes. Watch this video and read the article to understand the importance of teamwork on your unit.
Creator:
Duration: 5:48
Many fall prevention strategies exist with some degree of effectiveness. Watch this video and read the article to learn about a staff-driven QI initiative to develop a video in partnership with patients and families to prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%.
Creator: Diane Holland
Duration: 10:35
Are you worried about discharge delays in your institution? If so watch this video to learn how the authors developed and evaluated a mechanism for real-time tracking of discharge delays by bedside clinicians. They also developed a process for reporting delays so actions could be taken. Discharge delay times totaled 23.6 days for 114 patients affected by a delay. More than one-half of the delays (61.4%) were for patients whose discharge disposition was home.
Creator: Virginia Daggett
Duration: 4:39
The authors improved dysphagia-screening processes in a tertiary Veterans Affairs Medical Center. The dysphagia-screening tool was redesigned on the basis of frontline clinician feedback, clinical guidelines, user satisfaction, and multidisciplinary expertise. The revised tool triggered a speech-language consult for positive screens and demonstrated higher scores in user satisfaction and task efficiency. Systems redesign processes were effective for redesigning the tool and implementing practice changes with clinicians involved in dysphagia screening.
Creator: Erica Lewis
Duration: 4:51
Registered nurse (RN) “second victims” are RNs who are harmed from their involvement in medical errors. This study found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).
Creator: Carol Tuttas
Duration: 2:38
Travel nurses fulfill temporary full-time contracts in hospitals across the US, but little is known about their job performance and factors that influence their adjustment to the work setting. This mixed-methods study by Carol A. Tuttas identified the unique needs and characteristics of travel nurses.